Hand Pathologies Flashcards

1
Q

What is Duputren’s contracture?

A
  1. A proliferative connective tissue disorder
  2. Leads to the formation of nodules and cord
  3. Progresses to contractures at the MCP and PIP joints
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2
Q

What is the pathology behind Dupuytren’s contracture?

A
  1. Proliferation of myofibroblast cells
  2. Production of abnormal collagen (type 3 vs type 1)
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3
Q

Dupuytren’s contracture most commonly affects which fingers?

A
  1. Ring finger
  2. Little finger
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4
Q

What are the risk factors for developing Dupuytren’s contracture?

A
  1. Male gender
  2. North European/Scandinavian descent
  3. Alcoholic cirrhosis
  4. Phenytoin therapy
  5. Diabetes
  6. Other fibromatosis
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5
Q

Besides Dupuytren’s contracture, name two other fibromatoses

A
  1. Peyronie’s disease (penis)
  2. Lederhose disease (plantar fibromatosis)
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6
Q

What does surgery for Dupuytren’s contracture involve?

A
  1. Removal of diseased tissue (fasciectomy)
  2. Division of cords (fasciotomy)
  3. Amputation (for the most severe cases)
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7
Q

How is trigger finger caused?

A
  1. Tendonitis of a flexor tendon can cause nodular enlargement
  2. This can cause the tendon to get trapped under the fascial pulley
  3. Usually the involved pulley is the A1 pulley
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8
Q

Why may a patient who has trigger finger experience their finger becoming trapped in a flexed position?

A

The nodule of the flexor tendon (as a result of tendonitis) becomes trapped under the fascial pulley

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9
Q

Which fingers are most commonly implicated in trigger finger?

A

Middle and ring fingers

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10
Q

How can symptoms be quickly relieved in trigger finger?

A

Injection of steroid around the tendon

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11
Q

If trigger finger is recurrent, what is the treatment?

A

Surgery to incise the affected pulley to allow free movemnt of the tendon

(division of just the A1 pulley does not affect function)

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12
Q

Postmenopausal women are associayed with high rates of OA in which joints in the hand?

A

DIP joints

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13
Q

How may mild-moderate OA in the hand be treated?

A

Removal of osteophytes and excision of associated mucous cysts

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14
Q

How may severe OA in the hand be treated?

A

Arthrodesis

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15
Q

In order to preserve pincer grip, which treatment is required for OA at the index finger?

A

Arthrodesis

(other fingers can have replacement arthroplasty)

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16
Q

Which joints in the hand are least commonyl affected by OA?

A

MCP joints

17
Q

Which single joint in the hand is commonly affected by OA especially in women?

A

1st carpo-metacarpal joint

18
Q

How can OA in the 1st carpo-metacarpal joint be treated?

A
  1. Injection of steroid aids an acute flare up
  2. Excision arthroplasty (trapeziectomy) or fusion for chronic pain
19
Q

Which joints does RA avoid in the hand?

A

DIP joints

20
Q

What are the three stages of hand disease in RA?

A
  1. Synovitis and tenosynovitis (swelling and pain)
  2. Erosions of the joints (inflammatory pannus)
  3. Joint instability and tendon rupture (subluxation and chronic tenosynovitis may cause extensor tendon ruptures)
21
Q

What are the common hand deformities of RA?

A
  1. Volar MCP joint subluxation
  2. Ulnar deviation
  3. Swan neck deformity (hyperextension at PIPJ with flexion at DIPJ)
  4. Boutonniere deformity (Flexion at PIPJ with hyperextension at DIPJ)
  5. Z-shaped thumb
22
Q

Which procedure may prevent tendon rupture in RA?

A

Tenosynovectomy

23
Q

If extensor tendons to the wrist or fingers rupture in RA, which treatment is not suitable and which treatment is suitable for preserving function?

A
  1. Direct surgical repair cannot be undertaken due to the diseased state of the tendon
  2. Tendon transfers or joint fusions are required to preserve function
24
Q

How are

a) Contractures associated with RA treated
b) Affected joints with serve arthritic damage treated?

A

a) Soft tissue releases
b) Joint replacements or fusions